A retrospective analysis on the correlation between hip pain, physical examination findings, and alpha angle on MR images

Güler, Olcay; Isyar, Mehmet; Karataş, Dilek; Örmeci̇, Tuǧrul; Cerci, Halis; Mahiroğulları, Mahir

doi:10.1186/s13018-016-0476-9

Cited by 9 publications

(11 citation statements)

References 17 publications

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“…Clinical studies confirm have confirmed this by observing that patients with larger cam lesions report greater pain at lower ranges of motion. 35 Synthesizing our findings with the previous in vivo hip translation literature, we propose that hip translation depends on a combination of osseous factors, soft-tissue laxity, and hip position. Osseous factors promoting greater hip translation include poor acetabular coverage in the setting of acetabular dysplasia and larger alpha angles.…”

Section: Discussionsupporting

confidence: 78%

Assessment of Hip Translation In Vivo in Patients With Femoracetabular Impingement Syndrome Using 3-Dimensional Computed Tomography

Cvetanovich

Beck

Chalmers

et al. 2020

Arthroscopy, Sports Medicine, and Rehabilitation

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Purpose: To determine the 3-dimensional (3D) in vivo hip translation in patients with symptomatic femoroacetabular impingement syndrome (FAIS) using 3D computed tomography (CT) models with the hip in neutral and FABER (flexion, abduction, and the external rotation) positions and to identify patient predictors associated with the degree of hip translation. Methods: Seventy-eight patients with FAIS and cam lesions underwent CT scans in neutral and FABER positions. Demographics including age, sex, and body mass index (BMI) were recorded for each patient. The cam deformity was characterized both in plain x-ray film and 3D. Translation between both positions was calculated using a validated high-precision 3D-3D registration technique. Univariate and multivariate regression analyses sought factors correlated with translation. Results: The mean age of the patients included in the analysis was 36.3 AE 9.2 years, with 51% of the study group being female. The mean 3D femoral head center translation was 0.84 AE 0.37 mm, decomposed into vectors on standard anatomical directions as 0.13 AE 0.58 mm medial, 0.10 AE 0.54 mm posterior, and 0.08 AE 0.46 mm inferior. Multivariate analysis demonstrated that total translation was associated with larger alpha angles (b ¼ 0.014; 95% confidence interval [CI] 0.003-0.024; P ¼ .013), and greater BMI (b ¼ 0.033; 95% CI 0.001-0.065; P ¼ .042). Furthermore, posterioreinferior translation was associated with BMI (b ¼ 0.032; 95% CI 0.003-0.061; P ¼ .031), whereas medialelateral translation is associated with the female sex (b ¼ 0.388; 95% CI 0.124-0.634; P ¼ .002), and smaller head radius (b ¼ e0.068; 95% CI e0.128 to e0.007; P ¼ .029). Conclusions: As a provocative maneuver, FABER positioning in patients with FAIS resulted in an average measurable translation of the femoral head center in the posterior, medial, and inferior direction. Factors including sex, BMI, and alpha angle predicted the degree of translation. Clinical Relevance: The current study demonstrates that there is measurable hip translation between the neutral and FABER positions in patients with symptomatic FAIS, which may cause hip microinstability. Furthermore, the study found an association between hip translation and both modifiable and nonmodifiable factors. This may indicate the need for more comprehensive preoperative surgical planning, intraoperative dynamic examination of the hip, and consideration of capsular plication in certain patients.

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Section: Discussionsupporting

confidence: 78%

Assessment of Hip Translation In Vivo in Patients With Femoracetabular Impingement Syndrome Using 3-Dimensional Computed Tomography

Cvetanovich

Beck

Chalmers

et al. 2020

Arthroscopy, Sports Medicine, and Rehabilitation

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“…Allen et al 18 demonstrated a significant association between higher alpha angles in painful hips (mean 69.9°) than in asymptomatic hips (mean 63.1°). In a retrospective study of 334 patients, a significant association between hip symptoms and increased alpha angles ( P < .001) was observed as well 34 …”

Section: Discussionmentioning

confidence: 92%

The relationship between cam morphology and hip and groin symptoms and signs in young male football players

Klij

Ginai

Heijboer

et al. 2020

Scandinavian Med Sci Sports

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Background Conflicting and limited high‐quality prospective data are available on the associations between cam morphology and hip and groin symptoms and range of motion (ROM). Objectives This cross‐sectional cohort study investigated associations between cam morphology presence, size and duration and symptoms and ROM. Methods Academy male football players (n = 49, 17‐24 years) were included. Standardized antero‐posterior pelvic and frog‐leg lateral radiographs were obtained at baseline, 2.5‐ and 5‐year follow‐up. The femoral head‐neck junction was quantified by: Visual score. Cam morphology (flattening or prominence), large cam (prominence). Alpha angle. Cam morphology (≥60°), large cam (≥78°). Cam morphology duration was defined as long (first present at baseline) or short (only from 2.5‐ to 5‐year follow‐up). Current symptoms at 5‐year follow‐up were assessed using a hip and groin pain question and by the “Hip and Groin Outcome Score” (HAGOS). HAGOS scores were categorized into: most symptoms (≥2 domains in lowest interquartile range [IQR]), least symptoms (≥2 domains in highest IQR). Hip ROM was measured by goniometry at 5‐year follow‐up. Results Large cam morphology based on visual score was associated with hip and groin pain (23.8% vs. 7.1%, OR: 3.17, CI: [1.15‐8.70], P = .026), but not with HAGOS scores. Cam morphology presence, size, and duration were associated with limited flexion of around 6° and/or 3° to 6° for internal rotation. Conclusion Cam morphology presence, size, and duration were associated with limited hip flexion and/or internal rotation, but differences might not exceed the minimal clinical important difference. Whether cam morphology results in symptoms is uncertain.

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“…They found that pain was more commonly present in players with cam or mixed morphology, though only larger cam morphologies (increasing α-angle without specified cutoff value) were predictive for hip pain [5]. Furthermore, in a retrospective study by Guler et al, the α-angle was shown to be significantly higher in those with hip pain (55.9°) compared with those without (52.7°) [22]. An interpretation of this could mean that larger cam morphological changes might be painful earlier compared with smaller cam morphological changes that take longer to develop pain.…”

Section: Discussionmentioning

confidence: 97%

“…It is possible that this may explain the low or absence of a correlation between hip pain and the presence and size of cam morphology in this study. Both Khanna et al and Guler et al included a general population with a mean age of 29.5 and 33.8 years, respectively [22,23], and therefore had more years to develop hip pain. The duration of which cam morphology may have been present in this study might have been too short.…”

Section: Discussionmentioning

confidence: 99%

“…However, the association between cam morphology and hip pain has been questioned with conflicting levels of evidence being reported. Some studies have shown that a higher α-angle in individuals may be associated with hip pain and symptoms [5,21,22]. Furthermore, Khanna et al reported a relative risk of 4.5 (95% CI, 2.3-9.1) to develop hip pain in the presence of cam morphology (α-angle ≥ 60°) in the general population [23].…”

Section: Introductionmentioning

confidence: 99%

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Hip pain and its correlation with cam morphology in young skiers—a minimum of 5 years follow-up

Abrahamson¹,

Jonasson²,

Sansone³

et al. 2020

J Orthop Surg Res

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Background There is conflicting evidence regarding the association between cam morphological changes and hip pain, and it remains unclear who with cam morphology will develop hip pain and who will not. This study aimed to investigate the correlation between cam morphology, hip pain, and activity level at a 5-year follow-up in young Alpine and Mogul skiers. Method All students (n = 76) at Åre Ski National Sports High School were invited and accepted participation in this prospective study at baseline. Magnetic resonance imaging (MRI) of both hips was conducted to evaluate the presence of cam morphology (α-angle ≥ 55°) and its size alongside the reporting of hip pain, type, and frequency of training by the Back and hip questionnaire, at baseline. After 5 years, the skiers were invited to complete a shortened version of the same questionnaire. Results A total of 60 skiers (80%) completed the follow-up questionnaire, of which 53 had concomitant MRI data. Cam morphology was present in 25 skiers (47.2%, 39 hips). Hip pain at baseline and at follow-up was reported in 17 (28.3%) and 22 (36.7%) skiers, respectively. No correlations were found between the activity level, the frequency, and the size of cam morphology and hip pain, except for the right hip α-angle at 1 o’clock and hip pain in skiers with cam morphology at baseline (rs = 0.49; P = 0.03) and at follow-up (rs = 0.47; P = 0.04). A total of 73.3% skiers had retired, of which 48% reported this was due to injuries. Conclusion Hip pain was not shown to be correlated, or had a low correlation, with activity level and the presence and size of cam morphology in young skiers on a 5-year follow-up. Based on these results, cam morphology or activity level did not affect hip pain to develop during 5 years of follow-up in young skiers. Furthermore, this study highlights that almost 75% of young elite skiers had retired from their elite career with almost 50% reporting that this was due to injuries sustained from skiing.

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A retrospective analysis on the correlation between hip pain, physical examination findings, and alpha angle on MR images

Cited by 9 publications

References 17 publications

Assessment of Hip Translation In Vivo in Patients With Femoracetabular Impingement Syndrome Using 3-Dimensional Computed Tomography

Assessment of Hip Translation In Vivo in Patients With Femoracetabular Impingement Syndrome Using 3-Dimensional Computed Tomography

The relationship between cam morphology and hip and groin symptoms and signs in young male football players

Hip pain and its correlation with cam morphology in young skiers—a minimum of 5 years follow-up

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